In Vitro Fertilization for Infertility

Topic Contents

In Vitro Fertilization for Infertility

Treatment Overview

During in vitro fertilization (IVF), eggs
and sperm are brought together in a laboratory glass dish to allow the sperm to
fertilize an egg. With IVF, you can use any combination of your own eggs and
sperm and donor eggs and sperm.

Ovulation and egg retrieval. To prepare for an assisted reproductive procedure using your
own eggs, you will require hormone treatment to control your egg production
(ovulation). This is done to prevent unpredictable ovulation, which would make
it necessary to cancel that in vitro attempt. This is typically done using one
of two similar types of
gonadotropin-releasing hormone analogue (GnRH agonist or GnRH antagonist) . The following are two examples of how ovulation can be
controlled:

You first receive about 10 days of nasal or
injected GnRH agonist that "shuts down" your
pituitary. Next, you get daily ovary-stimulating
hormone injections and are closely monitored for 2 weeks before egg retrieval.
At home, you or your partner injects you with gonadotropin or
follicle-stimulating hormone (FSH) to make your
ovaries produce multiple eggs (
superovulation).

You start
treatment with FSH injections and then add the GnRH antagonist injection after
about 5 days, which stops the production of
luteinizing hormone (LH) within an hour or two.

After the first week, your doctor checks your blood
estrogen levels and uses
ultrasound to see whether eggs are maturing in the
follicles. During the second week, your dosage may
change based on test results. And you are monitored frequently with
transvaginal ultrasound and blood tests. If follicles fully develop, you are
given a human chorionic gonadotropin (hCG) injection to stimulate the follicles
to mature. The mature eggs are collected 34 to 36 hours later by needle
aspiration guided by ultrasound. You will usually have pain medicine and
sedation for this procedure.

Sperm collection. Sperm are collected by means of masturbation
or by taking sperm from a
testicle through a small incision. This procedure is
done when a blockage prevents sperm from being ejaculated or when there is
a problem with sperm development. Sperm may have been collected and frozen at an earlier time. Then the sperm are thawed on the day the eggs are collected.

Fertilization and embryo transfer. The eggs and sperm are placed in a glass dish and
incubated with careful temperature, atmospheric, and infection control for 48
to 120 hours. About 2 to 5 days after fertilization, the best fertilized eggs
are selected. One to three are placed in the uterus using a thin flexible tube
(catheter) that is inserted through the cervix. Those remaining may be frozen
(cryopreserved) for future attempts.

Pregnancy and birth. Any
embryos that implant in the uterus may then result in
pregnancy and birth of one or more infants.

What To Expect After Treatment

Overall, in vitro fertilization
(IVF)-related injections, monitoring, and procedures are emotionally and
physically demanding of the female partner. Superovulation with hormones
requires regular blood tests, daily injections (some of which are quite
painful), frequent monitoring by your doctor, and harvesting of eggs.

These procedures are done on an outpatient basis and require only a short
recovery time. You may have cramping during the procedure. You may be advised
to avoid strenuous activities for the remainder of the day or to be on bed rest
for a few days, depending on your condition and your doctor's
recommendation.

How Well It Works

Age.
Birth rates resulting from a single cycle of IVF using women's own eggs are
about 30% to 40% for women age 34 and younger, then rates decrease steadily after age
35.1 The
aging of the egg supply has a powerful effect on the chances that an assisted
reproductive technology (ART) procedure will result in pregnancy and a healthy
baby.

Cause of infertility. Infertility can be caused
by problems with the woman's or the man's reproductive system. Some of these
causes can include problems with the fallopian tubes, with
ovulation,
or with the sperm.

Pregnancy history. A
woman who has already had a live birth is more likely to have a successful ART
procedure than a woman who hasn't given birth before. This "previous birth
advantage" gradually narrows as women age from their early 30s to their
40s.

Own eggs versus donor eggs. Birth rates are affected by whether ART procedures use a
woman's own eggs or donor eggs. Many women over age 40 choose to use donor
eggs, which greatly improves their chances of giving birth to healthy babies.
For each cycle of in vitro fertilization:1

Using her own eggs, a woman's chances of having
a live birth decline from over 40% in her late 20s, to 30% at about age 38, and
to 10% by about age 43.

Live birth rates are about the same among younger
and older women using donor eggs. Women in their late 20s through mid-40s
average about a 55% birth rate using fresh (not frozen) embryos.

Frozen embryos versus fresh embryos. Donor-frozen IVF embryos from a previous IVF cycle that are thawed and transferred to
the uterus are less likely to result in a live birth than are donor-fresh
(newly fertilized) IVF embryos.1 But frozen embryos
are less expensive and less invasive for a woman, because superovulation and
egg retrieval aren't needed.

The risk of conceiving a multiple pregnancy is directly related to the number of embryos transferred to a woman's uterus.
Multiple pregnancies are high-risk for both the mother
and the fetuses.

There may be a higher risk of birth defects for babies conceived by certain assisted reproductive techniques, such as IVF. Talk with your doctor about these possible risks.

Embryo transfer success versus the risk of multiple pregnancy

For a woman over age 35 to maximize her chances of
conceiving with her own eggs and carrying a healthy pregnancy, she may choose
to have more embryos transferred than a younger woman would. But this increases
her risk of multiple pregnancy.

Because of the risks to the babies of multiple
pregnancy, experts recommend limiting the number of embryos transferred. Your doctor will recommend a certain number of embryos to be transferred based on your age and specific situation.

Women over 40
have a high rate of embryo loss when using their own eggs. As an alternative,
older women can choose to use more viable donor eggs. When a woman uses donor
eggs, experts recommend using the donor's age to help figure out how many
embryos to transfer.2

What To Think About

Smoking has
a damaging effect on fertility and pregnancy. Smoking reduces the chance that IVF will work.3
Smoking can also affect the health of the fetus.

In vitro
fertilization provides diagnostic information about fertilization and embryo
development (which is not the case with a
GIFT or ZIFT procedure).

Using ultrasound
to help collect eggs from the woman's ovaries is less expensive, less risky,
and less invasive than egg collection by
laparoscopy.

In the United
States, a cycle of in vitro fertilization costs approximately $10,000 to
$15,000.

If you and your doctor are concerned about passing on a
genetic disorder to your child, preimplantation genetic diagnosis might be
available. Some genetic disorders can be identified with specialized testing
before an embryo is transferred, increasing the chances of conceiving a healthy
child.

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